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May 10, 2018 - This post responds to several requests for our office to estimate the cost of providing full-scope Medi-Cal coverage to undocumented adults over the age of 19 who are currently eligible for restricted-scope Medi-Cal coverage (that is, primarily emergency and pregnancy-related services). Based on a number of key assumptions, we estimate the total net state cost of this coverage expansion is approximately $3 billion in 2018-19. This net cost would be fully a state cost, and represents the change between the cost of providing full-scope Medi-Cal and the costs of providing restricted-scope Medi-Cal to the undocumented adult population.
April 27, 2018 - In this post, we provide background on new staffing requirements for certified nursing assistants working in skilled nursing facilities, describe the Governor’s proposals to address these new staffing requirements, assess those proposals, and make associated recommendations.
March 21, 2018 - This budget brief analyzes the Governor’s 2018-19 budget proposal to eliminate the use of the 340B Drug Pricing Program in Medi-Cal. The Governor’s proposed statutory changes are intended to generate state savings and reduce the administrative complexity of complying with federal law on duplicate discounts when 340B prescriptions drugs are dispensed to Medi-Cal enrollees. We find that the Governor’s proposal merits serious consideration from the Legislature since, among other benefits, it would likely result in state savings that the Legislature could, in turn, use to fund its priorities. We note, however, that these savings would be in place of savings currently enjoyed by eligible healthcare providers. Before making a decision on the Governor’s proposal, we recommend that the Legislature ask the administration to provide the following key information on the Governor’s proposal: (1) the amount of Medi-Cal savings that would be generated, (2) the impact on healthcare providers currently participating in the 340B Program, and (3) the trade-offs of alternative policy approaches to addressing the challenges that are present due to the use of the 340B Program in Medi-Cal.
March 19, 2018 - In this post, we first provide background on the reimbursement rate used for certain child care providers. We then describe and assess the Governor’s related hold harmless provision and end by making associated recommendations.
March 14, 2018 - Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services
March 7, 2018 - Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services
March 2, 2018 - In this analysis, we describe the Financial Information System for California (FI$Cal) Project and the major changes to the project based on the newly released Special Project Report (SPR). We also describe the Governor’s 2018-19 budget proposal to fund activities associated with the new SPR at the State Controller’s Office. Finally, we make associated findings and recommendations.
March 1, 2018 - Proposition 55 (2016) aimed to increase funding for Medi-Cal under a formula administered by the Department of Finance. In 2018-19, the first year of implementation of this calculation, the administration’s interpretations and estimates result in no additional funds to Medi-Cal. Two key choices lead to this result. First, the administration’s decision to subtract $3.5 billion from available revenues to account for its proposed optional reserve deposit significantly reduces the calculation’s starting point, eliminating a surplus that would have directed funds to Medi-Cal. Second, the administration’s workload budget approach is based on a broad definition of currently authorized services, which also has the effect of reducing the amount of potential funds for Medi-Cal under the measure. Different decisions about these two features of the measure could result in more or less funding for Medi-Cal by hundreds of millions—or even billions—of dollars in the future.
February 16, 2018 - In this report we provide a broad overview of the Governor's health and human services budget, highlighting major year-over-year changes. We then provide a more in-depth analysis of select programmatic areas.
February 14, 2018 - Presented to: Senate Budget and Fiscal Review Committee
February 5, 2018 - Assembly Select Committee on Health Care Delivery Systems and Universal Coverage.
2/5/18: Correction to Figure 3.
January 31, 2018 - In this report, we (1) provide brief background information about Developmental Center (DC) closures and the Department of Developmental Services budget, (2) discuss potential savings in terms of net operational savings and increased revenues from the sale or repurposing (specifically leasing) of DC properties, and (3) address other practical implications and trade‑offs of the proposal.
January 23, 2018 - Recent Congressional action appropriates funding for the Children’s Health Insurance Program (CHIP) through federal fiscal year 2022-23. The federal cost share authorized by Congress for the program is higher than what was assumed in the Governor’s budget. These actions reduce estimated General Fund Medi-Cal costs by about $300 million in 2017-18 and about $600 million in 2018-19. As a result, we anticipate the May Revision will reflect $900 million in lower General Fund expenditures, and an equal amount of resources available for any purpose.
Updated 2/9/18: On Friday, February 9, 2018, Congress appropriated additional funding for CHIP through FFY 2026-27 at states' traditional cost share which, in California, is 35 percent. No changes were made to the previous reauthorization of CHIP funding through FFY 2022-23, discussed in this post.
Updated 2/9/18: Figure 1 updated to include Governor's funding assumptions through 2021‑22.
January 8, 2018 - The Supplemental Report of the 2017-18 Budget Act directed our office to report on the programmatic and fiscal implications of ending a long-standing state policy that provides Supplemental Security Income/State Supplementary Payment (SSI/SSP) recipients an extra $10 payment in lieu of their being eligible to receive federal food benefits through California’s CalFresh program. This is known as the SSI cash-out (or the CalFresh cash-out). In this report, we (1) describe how ending the SSI cash-out would affect households differently, (2) discuss the estimated statewide net effect of ending the SSI cash-out on federal food benefits drawn down by the state and how any variation in the underlying assumptions can create significantly different estimates, (3) provide examples of how ending the SSI cash-out would affect the poverty status of certain households, and (4) as directed by the Supplemental Report, discuss potential options the Legislature could consider to hold households negatively affected by the elimination of the SSI cash-out harmless and present additional issues that merit legislative consideration.
December 7, 2017 - In this report, we provide background regarding the objectives and operations of the Project Management Office (PMO), detail our findings in evaluating the PMO, introduce two significant recent developments and their impacts on the PMO, and make associated recommendations on how the Legislature should proceed to better align the office with the original legislative intent.